CHAPTER 29: CASE 4 – TUMOR OR CHARACTER?
The surgical suite is quiet except for the beep of monitors and the hum of ventilation. I'm not scrubbing in—Foreman drew that card—but I watch from the gallery as the neurosurgeon opens Marcus's skull with practiced precision.
The tumor is exactly where imaging predicted. Small, encapsulated, probably non-malignant. A neat little mass pressing against the part of the brain that makes people care about consequences.
Forty-five minutes later, it's out. No complications. Textbook procedure.
I head to the cafeteria for lunch, my appetite asserting itself after a morning of tension. The meatloaf looks vaguely threatening, but the mashed potatoes seem safe enough. I grab a tray and find a corner table, thinking about Marcus while I eat.
The tumor didn't make him a sociopath. I'm increasingly certain of this. The sealed juvenile records suggest behavior problems long before any medical issues. The pattern with business partners and employees extends back years. Marcus has always been this way—charming on the surface, hollow beneath—and the tumor just disrupted his control enough for people to notice.
But what does that mean for treatment?
We can remove the physical problem. We can fix the seizures, restore his executive function, send him home "cured." But we can't change who he is. We can't transplant a conscience.
Cameron slides into the seat across from me, holding a salad that looks far more sensible than my choices. "You look troubled."
"Thinking about Marcus."
"The surgery went well. Foreman said it was straightforward."
"The surgery isn't what's bothering me."
She waits, spearing a cherry tomato but not eating it. Patient. Ready to listen.
"I've been researching his background. Off the record." I lower my voice. "There's a pattern. Sealed juvenile records—probably violence. Business partners who left abruptly. Employees who transferred away. Everyone who gets close to him eventually distances themselves."
"That could be coincidence."
"Or it could be a trail of people who realized what he is."
Cameron frowns. "What do you think he is?"
"Antisocial personality disorder. Possibly sociopathy—true lack of empathy masked by learned charm." I pause, considering how much to share. "When I interviewed him, he didn't lie. Not once. But he also didn't... connect. Everything he said was technically correct, but there was no feeling behind it. Like he was performing 'nice person' rather than being one."
"The tumor could have caused that."
"Or revealed it." I push my potatoes around. "The tumor affected his frontal lobe—impulse control, social filtering. If he was always manipulative but good at hiding it, the tumor might have just stripped away his mask."
Cameron sets down her fork. "If that's true, what do we do?"
"Medically? Nothing. We removed the tumor. Job done."
"But?"
"But his wife doesn't know. She's married to someone who's been manipulating her for eighteen years, and she thinks he's wonderful. She deserves to know who she's actually living with."
The words hang between us. Cameron's expression shifts from concern to something more complicated—the internal battle between idealism and pragmatism that makes her such an effective advocate.
"We can't tell her," she says finally. "That's not our role."
"I know."
"But you want to anyway."
"I want someone to." I lean back. "We're doctors. We diagnose problems. He has a problem that isn't medical, and everyone around him is suffering because no one's willing to name it."
Cameron reaches across the table, her hand covering mine briefly. "You're a good person. That's why this bothers you."
"Being good doesn't fix anything."
"It's a start."
Post-operative evaluation happens that afternoon. Marcus is awake, alert, charming as ever. The neurosurgeon is pleased—reflexes normal, cognitive function intact, no signs of damage beyond the expected recovery period.
I watch him interact with his wife. She's tearful with relief, clutching his hand, telling him she was so scared. He responds with all the right words: "I'm fine, sweetheart. Don't worry about me. I'm just grateful you were here."
Perfect. Textbook. Completely empty.
House appears beside me, watching the same scene through the window. "Tumor's out. Personality's the same. What does that tell you?"
"It wasn't the tumor."
"No." House's voice is quiet, almost thoughtful. "It was never the tumor. The tumor just made him sloppy enough to get caught."
"What do we do?"
"We discharge him. We write a report documenting successful removal of a frontal lobe mass. We move on." House pauses. "Unless you have a different idea."
The question is a test. Everything with House is a test.
"We could flag it for psychology follow-up," I suggest. "Recommend ongoing evaluation. Plant the seed that something's not right."
"Which achieves what? He'll charm the psychologist the same way he charms everyone else."
"Maybe. Or maybe someone with training will see what we saw."
House considers this. "You really think a psychologist is going to diagnose antisocial personality disorder in a wealthy, successful, universally beloved businessman based on a post-op consult?"
"No." I meet his eyes. "But I think the paper trail matters. I think that six months from now, when his wife finally admits something's wrong, or one of his employees goes to HR, or a business partner starts comparing notes with others—having a flag in his medical record could make a difference."
House stares at me for a long moment. "You're playing a longer game than I expected."
"I'm playing the only game we have."
That night, after rounds, I make a decision.
I know a journalist. Not personally—the original Chase's memories include a contact from a medical ethics piece a few years back. Someone who covers business irregularities, who knows how to investigate without crossing legal lines.
I draft an email from an anonymous account. Careful wording. No patient information—that would be an ethics violation. Just a suggestion: certain business practices at Marcus Logistics might warrant investigation. Former employees might have stories to tell. The kind of tip that could lead somewhere without revealing its source.
I stare at the screen for ten minutes before hitting send.
It's not justice. It's not punishment. It's just... making sure the truth has a chance to surface through channels I can't control.
Is it ethical? I don't know. Marcus didn't break any medical rules. He didn't even lie to me—he just doesn't experience reality the way healthy people do. But his wife is building her life around a performance, and his employees are suffering under someone who views them as tools, and none of them will ever realize it unless something breaks the pattern.
This might break it. Or it might lead nowhere. Either way, I've done what I could.
Cameron texts me later that evening: You okay? You seemed quiet after the case.
I type back: Processing. Some patients stick with you.
Want to talk about it?
Not tonight. But thank you for asking.
Three dots appear, then disappear, then appear again.
Friday still works for me.
I smile despite myself. Looking forward to it.
I close my phone and stare at the ceiling. The Marcus case is closed—medically speaking. The tumor's removed, the patient's stable, the paperwork's filed. Victory, by every metric that matters.
But I used my abilities to judge someone. To act on information I gathered through observation and deduction rather than legitimate medical channels. To make a decision about someone's life that wasn't mine to make.
House would say I did the right thing. Cameron would probably argue I crossed a line. Foreman would call it pragmatic.
I don't know what to call it.
I just know that Sarah Marcus deserved better than a lifetime of manipulation, and I couldn't walk away without doing something.
Whether that makes me a hero or just another person playing god... I'll have to figure that out later.
For now, I have a coffee date to look forward to.
That's enough.
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